The SERI Distal Metatarsal Osteotomy and Scarf Osteotomy Provide Similar Correction of Hallux Valgus

Abstract

Background Ideal surgical treatment for hallux valgus is still controversial. A traditional distal metatarsal osteotomy with rigid fixation (Scarf procedure) and a more minimally invasive approach to a distal metatarsal osteotomy, termed SERI (Simple, Effective, Rapid, Inexpensive), have proven successful with short-term followup. However, no data are available directly comparing the two procedures. Questions/Purposes We performed a prospective randomized trial to determine which technique (SERI or Scarf) was associated with (1) better functional outcomes, (2) better radiographic correction, and (3) fewer complications at 2 and 7 years followup. Methods Twenty patients, 53 ± 11 years of age, with bilateral hallux valgus, clinically and radiographically similar, underwent bilateral surgery with Scarf on one side and SERI on the other, at random. Clinical (AOFAS score) and radiographic assessments were considered before surgery, and at 7 years followup. Results SERI and Scarf techniques provided correction of the hallux valgus angle, intermetatarsal angle, and distal metatarsal angle in the range of normal. Both led to similar clinically important improvements in the AOFAS.No differences were observed between the groups. All osteotomies healed, and two patients who underwent the Scarf procedure required hardware removal. Reduction of ROM with respect to preoperative was observed in three patients for SERI and three patients for Scarf procedures. Conclusions Scarf and SERI techniques resulted in effective correction of hallux valgus with similar outcomes, however the SERI technique required a shorter skin incision, less surgical time, less expensive fixation device, and was without residual pain attributable to hardware.

Minimally invasive hallux valgus surgery: a critical review of the evidence

“…Maffulli et al [33] Reported complications vary among the studies. While Giannini et al [34] reported no complications at all in their comparative series, other authors noted complications. Bösch reported in 1990 pin track infection in 9.5 % and Roth et al [32] in 15 %.…”

“…Roth et al [32] presented a retrospective comparative study of the percutaneous (Bösch) Giannini et al [34] performed a prospective comparative study of the SERI (simple, effective, rapid, inexpensive) and Scarf osteotomies. Twenty patients with bilateral hallux valgus deformities underwent a Scarf on one side and a SERI osteotomy on the other side.…”

“…While Bösch et al [22], Scala and Vendettuoli [36], Sun et al [37], Giannini et al [34] and Radwan and Mansour [31] did not report metatarsal head position at follow-up, Magnan et al [27] reported 61 %, Enan et al [35] 55.6 % and Iannò et al [28] 4.7 % dorsal or plantar malalignment.…”

Bösch technique for hallux valgus surgery in a tropical setting

“…Minimally invasive surgery in foot surgery is becoming increasingly popular. 5,6 The Bö sch technique 7 (BT) is a minimally invasive procedure without lateral release of soft tissues commonly performed for mild and moderate HV. This procedure is popularized by Magna 8 and Giannini.…”

Reply to comments by Wu et al. regarding our manuscript titled: A minimally invasive technique for surgical treatment of hallux valgus: simple, effective, rapid, inexpensive (SERI)

“…The main issue still remains: that there are numerous surgical procedures by which to manage hallux valgus, and no single intervention technique can be considered better than the others. We consider the SERI technique a solid, rapid and reproducible technique that, in selected patients, is associated with positive results, low costs and an acceptable complication rate; it was also recently demonstrated in a prospective case-control study that compared outcomes of the SERI procedure against a Scarf osteotomy [8]. Finally, we acknowledge that careful preoperative patient evaluation, which includes assessing the hindfoot and barefoot and general health status of the patient is quintessential for adequate surgical planning and optimising clinical outcomes.…”